Study Yields Key Findings For All Veterans' Care

The largest and most up-to-date study of suicides among depressed veterans provides important new data that may help guide screening and treatment for all veterans.

The depression treatment differ from those seen in the general American population, with younger, white, non-Hispanic men having the highest risk among the veterans.

Veterans with substance abuse issues, and those who had been hospitalized for psychiatric reasons in the year before their depression diagnosis, also had a higher suicide risk. Surprisingly, older veterans who had been diagnosed with post-traumatic stress disorder in addition to depression had a lower overall rate of suicide than those without a PTSD diagnosis, perhaps because they were more likely to receive care through Veterans Affairs PTSD programs.

Though the study did not directly compare populations of veterans and non-veterans receiving treatment for depression, the study does confirm that suicide rates were very high among depressed VA patients during the study period of 1999 to 2004, reinforcing the need for the VA's recent initiatives to prevent suicide.

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The study, conducted by researchers from the VA Ann Arbor Healthcare System and the University of Michigan Health System and U-M Depression Center, will appear in the December American Journal of Public Health issue focused on veterans' issues.

The researchers analyzed comprehensive data from 807,694 veterans of all ages diagnosed with depression and treated at any Veterans Affairs facility nationwide between 1999 and 2004. The data are from the VA's National Registry for Depression, developed and maintained by the Serious Mental Illness Treatment Research and Evaluation Center at the VA Ann Arbor's Health Services Research and Development Center of Excellence.

In all, the researchers found that 1,683 of the depressed veterans committed suicide during the study period, representing 0.21 percent of the depressed veterans studied. They then analyzed the characteristics of all the depressed veterans who committed suicide, and calculated suicide hazard ratios and suicide rates per 100,000 person-years for each subgroup.

"Doctors learn about patient characteristics that might increase risk of suicide," says first author Kara Zivin, Ph.D., a VA investigator and assistant professor in the U-M Department of Psychiatry. "Typically, these are older age, male gender, and white race, as well as depression, and medical or substance abuse issues. But our study indicates that among veterans in depression treatment, the predictors of suicide may not be the same. We hope our findings will help guide physicians in understanding suicide risk among currently depressed veterans."

Zivin and senior author Marcia Valenstein, M.D., an associate professor of psychiatry at U-M and leader of this study, note that these data are but the first of many findings that will likely emerge from analysis of the VA data.

"We are also examining whether there are specific periods during depression treatment when veterans are at higher risk and might need higher levels of monitoring," says Valenstein. "In addition, we are examining whether different types of depression treatments, such as different antidepressants or sleeping medications, are associated with different rates of suicide."

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